Impacted subcapital fracture9/15/2023 ![]() ![]() On the initial AP view with external rotation no fracture is seen or even suspected. 9-4 B ) that is not apparent on the initial examination.ĪP view example that demonstrates difficulty in seeing fractures with external rotation shown ( A ). However, the repeat, properly positioned AP view clearly depicts a widely separated fracture of the greater tuberosity ( Fig. On the initial AP view with external rotation no fracture is seen or even suspected ( Fig. An even more striking example of difficulty in seeing fractures on the AP view with external rotation is shown in Fig. Note that an impacted subcapital fracture is now visible. A repeat PA view should be obtained with slight internal rotation of the femur ( Fig. Subcapital fractures, particularly nondisplaced fractures, are obscured and readily overlooked ( Fig. External rotation of the hip on the AP view without a femoral neck fracture is a common occurrence ( C ). A displaced fracture of the femoral neck showing the distal fragment in external rotation with the femur drawn proximally ( B ). Fractures of the femoral neck are difficult to identify on such views.ĪP view showing slight internal rotation of the hip ( A ) best profiles the head and neck junction to identify femoral neck and intertrochanteric femur fractures. External rotation of the hip foreshortens the femoral neck, and the underlying greater trochanter obscures the femoral head and neck junction. External rotation of the hip on the AP view in the absence of a femoral neck fracture is, unfortunately, a common occurrence ( Fig. With a displaced fracture of the femoral neck the distal fragment lies in external rotation, and the femur is drawn proximally ( Fig. 9-2 A ) best profiles the head and neck junction, which facilitates identification of fractures of the femoral neck and intertrochanteric femur. The AP view with slight internal rotation of the hip ( Fig. The groin lateral ( D, E ) is an optional view of the femoral head and neck that better demonstrates posterior rotation of the femoral head in the presence of subcapital fractures. Radiographic view of the traumatized hip: An AP of the pelvis ( A ) showing the surrounding bony pelvis for fractures that can mimic hip fractures an AP view of the hip ( B ) in internal rotation to place the femoral head and neck in profile the frog-leg view ( C ) with leg abducted and externally rotated results in a modified lateral view of the proximal femur. 9-1 D and 9-1 E ) is an optional view of the femoral head and neck that better demonstrates posterior rotation of the femoral head in the presence of subcapital fractures. 9-1 C ) is obtained with leg abducted and externally rotated, in effect, resulting in a modified lateral view of the proximal femur. If this view shows no evidence of hip fracture, the toes should be brought together by wrapping the forefeet in a towel to place the hip in internal rotation, and a repeat AP view should be obtained. If the patient’s foot is in external rotation and he or she is unable to rotate the foot, the AP view should be taken as the patient lies, because with displaced fractures of the femoral neck the hip is typically held in external rotation. 9-1 B ) should be obtained with the hip in internal rotation to place the femoral head and neck in profile. 9-1 A ) is included to survey the surrounding bony pelvis for fractures (i.e., pubic rami and iliac wings), which can mimic hip fractures. Where else to look when you see something obviousĪ radiographic examination of the traumatized hip should include the four standard views listed above. Proximal injuries of the hip in association with femoral shaft fractures Proximal femoral epiphyseal separation rare Hip fractures rare in children and adolescents Pelvic fractures presenting as hip fractures ![]() Elderly – low-impact trauma (fall from standing height) ![]()
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